NR 509 FINAL 2025/2026 VERIFIED
SOLUTIONS LATEST EDITION
Know \that \in \a \47-year-old \man \ED \is \usually \___________ \rather \than \testosterone \- \ANS-psychologic
Erectile \dysfunction \may \be \from \psychogenic \causes, \especially \if \- \ANS-early \morning \erection \is \
preserved.
it \may \also \reflect \decreased \testosterone, \decreased \blood \flow \in \the \hypogastric \arterial \system, \
impaired \neural \innervation, \and \diabetes
When \performing \a \breast \exam, \know \what \abnormal \masses \should \do \when \the \arm \- \ANS-may \be \
fixed \to \skin \or \underlying \tissues \(may \cause \dimpling \of \skin \or \retraction \when \arms \are \lifted \over \
head \or \hands \are \pressed \against \hips)
Fibroadenoma \and \cysts \mobility \- \ANS-very \mobile/mobile
Know \that \a \high \proportion \of \breast \masses \are \noted \during \________ \- \ANS-BSE
Breast \stage \1 \- \ANS-preadolescent- \elevation \of \nipple \only
Breast \stage \2 \- \ANS-breast \bud \stage- \elevation \of \breast \and \nipple \as \a \small \mound; \enlargement \
of \areolar \diameter
breast \stage \3 \- \ANS-further \enlargement \of \elevation \of \breast \and \areola, \with \no \separation \of \
their \contours
breast \stage \4 \- \ANS-projection \of \areola \and \nipple \to \form \a \secondary \mound \above \the \level \of \
breast
, breast \stage \5 \- \ANS-mature \stage- \projection \of \nipple \only; \areola \has \receded \to \general \contour \of \
the \breast \(although \in \some \individuals \the \areola \continues \to \form \a \secondary \mound)
Know \where \pain \is \located \with \pancreatitis: \acute \- \ANS-epigastric, \may \radiation \straight \to \the \
back \of \other \areas \of \the \abdomen; \20% \with \severe \sequelae \of \organ \failure
Know \where \pain \is \located \with \pancreatitis: \chronic \- \ANS-epigastric, \radiating \to \back
Know \how \hepatitis \A \is \transmitted \- \ANS-Transmitted \through \fecal-oral \route. \Fecal \shedding \
followed \by \poor \handwashing \contaminates \water \and \foods \leading \to \infection \of \household \and \
sexual \contacts
Stress \incontinence \- \ANS-the \urethral \sphincter \is \weakened \so \that \transient \increases \in \intra-
abdominal \pressure \raise \the \bladder \pressure \to \levels \that \exceed \urethral \resistance. \Causes \
include \childbirth \and \surgery, \postmenopausal \atrophy \of \the \mucosa, \and \urethral \infection. \May \
follow \prostate \surgery \in \men.
urge \incontinence \- \ANS-detrusor \contractions \are \stronger \than \normal \and \overcome \the \normal \
urethral \resistance. \The \bladder \is \typically \small. \Mechanisms: \Decreased \cortical \inhibition \of \
detrusor \contractions \from \stroke, \brain \tumor, \dementia, \and \lesions \of \the \spinal \cord \above \sacral \
level. \Also \hyperexcitability \of \sensory \pathways \ie: \bladder \infections, \tumors, \and \fecal \impaction. \
Deconditioning \of \voiding \reflexes \ie: \frequent \voluntary \voiding \at \low \bladder \volumes.
overflow \incontinence \- \ANS-detrusor \contractions \are \insufficient \to \overcome \urethral \resistance, \
causing \urinary \retention. \The \bladder \is \typically \flaccid \and \large, \even \after \an \effort \to \void. \
Mechanisms: \obstruction \of \the \bladder \outlet \ie: \BPH \or \tumor. \Weakness \of \the \detrusor \muscle \
associated \with \peripheral \nerve \disease \at \S2-4 \level. \Impaired \bladder \sensation \that \interrupts \the \
reflex \arc \ie: \diabetic \neuropathy.
functional \incontinence \- \ANS-the \patient \is \functionally \able \to \reach \the \toilet \in \time \because \of \
impaired \health \or \environmental \conditions. \Mechanism: \problems \in \mobility \resulting \from \
weakness, \arthritis, \poor \vision, \or \other \conditions. \Also \environmental \factors \such \as \an \unfamiliar \
setting, \distant \bathroom \facilities, \bed \rails, \or \physical \restraints.
SOLUTIONS LATEST EDITION
Know \that \in \a \47-year-old \man \ED \is \usually \___________ \rather \than \testosterone \- \ANS-psychologic
Erectile \dysfunction \may \be \from \psychogenic \causes, \especially \if \- \ANS-early \morning \erection \is \
preserved.
it \may \also \reflect \decreased \testosterone, \decreased \blood \flow \in \the \hypogastric \arterial \system, \
impaired \neural \innervation, \and \diabetes
When \performing \a \breast \exam, \know \what \abnormal \masses \should \do \when \the \arm \- \ANS-may \be \
fixed \to \skin \or \underlying \tissues \(may \cause \dimpling \of \skin \or \retraction \when \arms \are \lifted \over \
head \or \hands \are \pressed \against \hips)
Fibroadenoma \and \cysts \mobility \- \ANS-very \mobile/mobile
Know \that \a \high \proportion \of \breast \masses \are \noted \during \________ \- \ANS-BSE
Breast \stage \1 \- \ANS-preadolescent- \elevation \of \nipple \only
Breast \stage \2 \- \ANS-breast \bud \stage- \elevation \of \breast \and \nipple \as \a \small \mound; \enlargement \
of \areolar \diameter
breast \stage \3 \- \ANS-further \enlargement \of \elevation \of \breast \and \areola, \with \no \separation \of \
their \contours
breast \stage \4 \- \ANS-projection \of \areola \and \nipple \to \form \a \secondary \mound \above \the \level \of \
breast
, breast \stage \5 \- \ANS-mature \stage- \projection \of \nipple \only; \areola \has \receded \to \general \contour \of \
the \breast \(although \in \some \individuals \the \areola \continues \to \form \a \secondary \mound)
Know \where \pain \is \located \with \pancreatitis: \acute \- \ANS-epigastric, \may \radiation \straight \to \the \
back \of \other \areas \of \the \abdomen; \20% \with \severe \sequelae \of \organ \failure
Know \where \pain \is \located \with \pancreatitis: \chronic \- \ANS-epigastric, \radiating \to \back
Know \how \hepatitis \A \is \transmitted \- \ANS-Transmitted \through \fecal-oral \route. \Fecal \shedding \
followed \by \poor \handwashing \contaminates \water \and \foods \leading \to \infection \of \household \and \
sexual \contacts
Stress \incontinence \- \ANS-the \urethral \sphincter \is \weakened \so \that \transient \increases \in \intra-
abdominal \pressure \raise \the \bladder \pressure \to \levels \that \exceed \urethral \resistance. \Causes \
include \childbirth \and \surgery, \postmenopausal \atrophy \of \the \mucosa, \and \urethral \infection. \May \
follow \prostate \surgery \in \men.
urge \incontinence \- \ANS-detrusor \contractions \are \stronger \than \normal \and \overcome \the \normal \
urethral \resistance. \The \bladder \is \typically \small. \Mechanisms: \Decreased \cortical \inhibition \of \
detrusor \contractions \from \stroke, \brain \tumor, \dementia, \and \lesions \of \the \spinal \cord \above \sacral \
level. \Also \hyperexcitability \of \sensory \pathways \ie: \bladder \infections, \tumors, \and \fecal \impaction. \
Deconditioning \of \voiding \reflexes \ie: \frequent \voluntary \voiding \at \low \bladder \volumes.
overflow \incontinence \- \ANS-detrusor \contractions \are \insufficient \to \overcome \urethral \resistance, \
causing \urinary \retention. \The \bladder \is \typically \flaccid \and \large, \even \after \an \effort \to \void. \
Mechanisms: \obstruction \of \the \bladder \outlet \ie: \BPH \or \tumor. \Weakness \of \the \detrusor \muscle \
associated \with \peripheral \nerve \disease \at \S2-4 \level. \Impaired \bladder \sensation \that \interrupts \the \
reflex \arc \ie: \diabetic \neuropathy.
functional \incontinence \- \ANS-the \patient \is \functionally \able \to \reach \the \toilet \in \time \because \of \
impaired \health \or \environmental \conditions. \Mechanism: \problems \in \mobility \resulting \from \
weakness, \arthritis, \poor \vision, \or \other \conditions. \Also \environmental \factors \such \as \an \unfamiliar \
setting, \distant \bathroom \facilities, \bed \rails, \or \physical \restraints.
